Telenursing with elderly people in home care service during the COVID-19 pandemic: quasi-experimental study

Abstract Objective: to evaluate telenursing as a support technology in the transition of care for elderly people and their caregivers in the context of home care during the COVID-19 pandemic. Method: quasi-experimental before-after, non-randomized study, with 219 elderly people and caregivers from the home care service, divided into 131 in the intervention groups and 88 in the control group. Analytical treatment, descriptive and inferential statistics were carried out. Results: 1691 calls were made, 1515 to the intervention group and 176 to the control group. It was observed that in the first call there is a greater need for interventions to promote health and this quantity decreases throughout the calls with a significant result (p-value < 0.001). The outcomes analyzed were hospitalization, death, discharge or continuation of the home care service and it was observed that the chance of discharge from the service was nine times greater in the intervention group. Continuity of care from the home care service and discharge after the end of the calls were also significant (p-value < 0.001). Conclusion: telenursing was a technology to support care, mainly for health promotion and discharge from home care services.


Introduction
With the worsening of the COVID-19 pandemic, due to the dissipation of the Coronavirus Disease-19 (COVID-19), which developed so quickly and dramatically, health services collapsed and were unable to respond quickly to the routine of the work process.The beginning of this health chaos began in December 2019, from bronchoalveolar lavage samples obtained from patients with pneumonia of unknown cause in Wuhan, Hubei province, China, when the betacoronavirus called Severe Acute Respiratory Syndrome Coronavirus-2 (Sars-Cov-2) (1)(2)(3) was discovered.
During the COVID-19 pandemic, there was greater concern about the elderly population because they represent 31.2 million people in Brazil, corresponding to almost 15% of the total population (4) and, due to the aging process, there is a compromised of the immune system which, when associated with chronic diseases intrinsic to age, can promote increased vulnerability to severe forms of COVID-19, leading to death (5) .This was proven with the first confirmed death being that of a 62-year-old man, diagnosed with diabetes mellitus and high blood pressure (6) and with studies that demonstrated that the highest fatality rate in Brazil was among the age group over 60, representing 69.3% of confirmed deaths in 2020 and 64% of these deaths had at least one risk factor such as heart disease, diabetes mellitus, kidney disease, among others.The board of the World Health Organization and China presented studies that the same comorbidities in the elderly population are indicators of greater risk for mortality due to COVID-19 (5,7) .
Given this scenario and with frontline healthcare professionals significantly affected by this new disease, an opportunity has opened up to provide long-distance healthcare services due to the high degree of transmission and contamination of the Sars-Cov-2 virus, in addition to the overload of the health network and the priority of hospital care for serious cases.This strategy is a concept known as telemedicine since the 90s and is conceptualized as the use of information and communication technologies to provide health care.This concept applied to nursing is called telenursing and has wide application and effectiveness in health care, management, assistance, teaching and research services, in addition to the advantages of expanding health coverage and reducing costs.Then, with the rapid advancement of the pandemic, national bodies were compelled to transform the telemedicine and telenursing support service into the main patient care strategy (8)(9)(10)(11) .This scenario is based on and justified by the Transition Theory, which consists of "the transition from one state, condition or location to another" and which begins through uncontrollable events (12) .In this context, the COVID-19 pandemic, which forced physical and social isolation around the world, presented itself as one of these uncontrollable events, which provided elderly people with a transition in care, more specifically from in-person to remote care.This theory has a strong influence on nursing intervention, based on transitional care with a relationship between the elderly person-caregiver-nurse planned prior to life-changing situations, with strategies in the transitional care process that improve people's quality of life, reducing the potential risk that the transition experience can provide.In this study, the phases of the transition process were divided into the entry phase, with the beginning of the pandemic and telephone contact, passage through the telephone intervention process, and exit, in this study identified as the outcome.This outcome can be positive, which would be no contamination by COVID-19 and continuity of care for chronic comorbidities, or negative, which would be contamination or discontinuity of care, causing hospitalizations or deaths (12)(13) .
In this theory, it is also understood that the transition is essentially positive, as in the process, greater maturity and stability are obtained and, when applied to nursing care carried out over the telephone, they tend to be apprehended and reproduced, since there is no intermediary Only the caregiver can do it.Furthermore, if this transition causes anxiety, disorientation, irritability and stress, the telephone is an easy and immediate means of communication to assist in this process and achieve success and coping, as described in transition theory (12)(13) .
To then act on the transition from face-to-face to remote care with nursing interventions specifically aimed at elderly people and caregivers, nursing diagnoses from the NANDA-I Taxonomy (14) were used, based on diagnoses of risk of tension in the role of the caregiver, risk of infection, and risk of frail elderly syndrome.Associated with nursing diagnoses, the NIC (15)

Study design
This is an excerpt from the doctoral thesis entitled "Telenursing in the Continuity of Care for the Elderly and Caregivers in the HCS During COVID-19: a quasiexperimental study" to evaluate telenursing as a support technology in the transition of care to the elderly and their caregiver in the COVID-19 pandemic.Quasi-experimental, before-and-after, non-randomized study.In order to construct the method, CONSORT was used.

Study setting
The research was developed at HCS in São Gonçalo, RJ, Brazil.

Period
The study was carried out from March to May 2020.

Population
The study population was made up of elderly people registered with the HCS and their caregivers.
Due to the COVID-19 pandemic and the cooperation agreement established with the HCS, a telephone directory was provided with all registered patients and care provided by that service, which comprised 392 people, including children, adults and elderly people.

Selection criteria
The inclusion criteria were: being registered with the HCS; being 60 years old or over.If you have a caregiver: being the main caregiver of the elderly person accompanied by the HCS; agree to participate in the research; being able to respond to the researcher's questions in a coherent manner and having a landline or cell phone.
The discontinuation criteria applied: not answering the first call after three attempts; not answering at least 25% of telephone calls after the start of the nursing teleconsultation.
It should be noted that one of the criteria for being registered with a home care service of the Unified Health System is having a caregiver (16) , so all registered people had caregivers linked to the registration form, who could be family or professional, but in practice not all of them had their caregivers present at the time of the call or omitted the information from the service so that they could receive health care even without a caregiver, so the instrument was applied according to who answered the call.

Sample definition and data collection
The sample size was determined by carrying out a sampling methodology that estimated the proportion of home care service outcome results in two populations, in this case: control and intervention.In this sense, whether p 1 is the proportion of discharges from the home care service in the control group and whether p 2 is the proportion of cases in the intervention group, it is necessary to measure the difference p 1p 2 , also known as the difference in risks (17) .For the calculation, information from pilot studies and previous information from already known or published studies were necessary (18) .In the pilot study, we found the following values p 1 =0.05 and p 2 =0.

Instruments
The research team, formed by the main researcher, in addition to two nurses and two nursing students, created two connection instruments to be used in telephone contact, one for the intervention group and one for the control group (Figure 2), which served to guide the telephone calls made.
The instrument in Figure 1 was developed in light of gerontological assessment and based on Transition Theory (12,19) .It was drawn up in a systematic way with the aim of developing an adequate plan of care and support in the intervention of the general condition of the elderly person and their caregiver related to the care of both during the investigation of the flu syndrome and social isolation in times of COVID-19.
The telecare questions and interventions were prepared in accordance with the legal duties of the nursing professional, based on the diagnoses of risk of tension in the caregiver role, risk of infection and risk of frail elderly syndrome from the NANDA-I Taxonomy (14) , associated with these diagnoses, respectively, the NIC (15) (20) .Regarding the comparison of assessments and   were not included in the study before the start of data collection and subsequently preliminary data were published indicating the validation of the instrument (21) .

Data processing and analysis
The

Ethical aspects
The The benefits of the study deal with the social, academic and professional contribution to the consolidation of innovative nursing care in the public body, low cost and easy to manage, used to support the service of nursing teams, promoting assistance in health promotion, adherence treatment, psychological comfort, screening and prevention of health complications in elderly people.
After the end of the study, the control group received all calls with the appropriate nursing interventions in the same period.

Results
The present study included a total of 1691 calls, of which 1515 calls were made to the 131 participants in the intervention group and 176 calls to the 88 participants in the control group, using the appropriate call instruments for each group.
The results in Table 1 detail the characteristics of the study participants, as well as the separation by group analyzed (control and intervention).Fisher's Exact test was applied to evaluate the percentage distribution of the characteristic in relation to the analyzed groups, that is, its homogeneity.In Table 3, the existence of a difference in the percentage of responses for each outcome is assessed in relation to the control and intervention groups.There is a difference in the outcomes analyzed (p-value < 0.001).
It is observed that in the discharge outcome, the result was percentage significant in the intervention group, so of the cases that were discharged from HCS (36) , almost 84% were in the intervention group.It is important to highlight that the discharge from HCS was carried out by the service team as the research progressed and the patient's evaluations were positive.Rev. Latino-Am.Enfermagem 2024;32:e4320.To consider these results in the best way, the use of the Odds Ratio was applied and these results were compared with the "discharge" outcome with the other outcomes.In this analysis, it was observed that the chance of discharge in the intervention group was higher when compared to other outcomes in the control group.Thus, having a "high" result is almost nine times more likely to occur in the intervention group than in the control group.

Discussion
Given the moment of transition in health experienced in the world due to the COVID-19 pandemic, consecutively in the lives of the binomial elderly people and their caregivers served by HCS, it provided the possibility of using technological resources mediated by telenursing, in supporting the continuity of care for elderly people and their caregivers assisted by the service.
In an unprecedented way, the study was developed at the height of the COVID-19 pandemic, based on the scientificity of the combination of the Transition Theory (12,19) , the NANDA I Standardized Language System (14) and NIC (15) for documental guidance of the connection instrument and also the regulation of COFEN Resolution 696/2022 (22) .The combination of transition theory through response patterns, indicators of the process of caring for elderly people and their caregivers, feeling connected to professionals, interacting even over the telephone, being situated and developing trust and coping enabled the foundation of data collection.
The standardized languages of the NANDA I (14) and NIC (15) Taxonomies were crucial in identifying the main International studies in the 1990s already showed that approximately half of all patients who go to home care need continuity of qualified nursing care.These highlight that, at the time of discharge from hospital, patients are still very weak and have not recovered enough to learn the necessary self-care procedures (23) .
With this, the home care environment emerges through TeleHomeCare Technology; that is, the studies also predicted that this technology would help provide the necessary level of care and services for home care to older people and their caregivers by registered home care nurses proficient in TeleHomeCare.In view of this, studies have already highlighted that in situations of public calamity, creativity and the search for remote care strategies overcome the challenges imposed by distancing measures and become part of the agenda of health systems in different care contexts (23) .
Due to the state of public calamity and the study It is worth mentioning that health professionals needed to be qualified to develop innovative skills/ competencies to guarantee the quality, safety and efficiency of care through technology.This justifies the creation of the call instrument based on the transition from in-person to remote care during the COVID-19 pandemic (24) .
As with other regulations on access to society's data, telenursing must also be previously consented to by the patient or their legal representative, and its implementation is the responsibility of the nurse.
Registration of the teleconsultation was mandatory and based on the nursing process (nursing consultation, diagnosis, planning, intervention and evaluation), to organize and guide care for elderly people and their caregivers.Thus, in the calls, elderly people and their caregivers at HCS were approached regarding data collection based on the combination of transition theory, diagnoses were extracted from the NANDA-I (14) domains: family roles and relationships, safety/ health protection and promotion.
In domain I Health Promotion, the diagnosis Risk for Frail Elderly Syndrome was extracted, because, despite there being no consensual definition, frailty can be understood as a multidimensional syndrome, which involves the complex interaction of biological, psychological and social factors.This interaction culminates in greater vulnerability and is associated with the risk of clinical outcomes such as functional decline, falls, malnutrition, hospitalization and death.
Therefore, a nursing care plan regarding these signs and symptoms was essential.The NIC interventions were related to the nursing diagnosis regarding the prevention of acute complications, guiding the adoption of a balanced diet, personal care and staying active (25) .
In consecutively, the feelings of isolation, sadness and anxiety on the part of this binomial, elderly people and their caregivers, were also increased (26)(27) .
This data is in line with the present study, considering the high percentage of elderly people who had more female caregivers than male caregivers, as shown in Table 1.There was also identification of the female gender for caregivers who did not receive remuneration, which is in line with of studies on the care provided to elderly people (28) .
In the calls made to elderly people and their caregivers, it was possible to observe the need for a different perspective from the State, society and families regarding organization and family planning.
Studies already narrate the importance of including the caregiver not only as an executor of planned actions, but as the main subject in the promotion and quality of care, when the elderly person loses the condition of self-care.
The visibility of the caregiver's role was relevant in the study since, through it, it was possible to provide health care to Binomial, an elderly person and caregiver.Public health policies are necessary to cover comprehensive care for the health of elderly people and their caregivers, after all, the caregiver is on the "anonymous front line" in caring for elderly people, not only during the COVID-19 pandemic, but as a requirement for the elderly person's adherence to the Home Care Service (29) .
Telenursing brought about a significant number of interventions in the first call and was maintained during the first four weeks due to the panic that set in among citizens, due to the uncertainties and deaths that were being caused by the pandemic.The pandemic state did not make it possible for the HCS team to visit in person and health care for the population in general was hampered.
In this sense, telenursing as support in nursing interventions in the continuity of care for elderly people and their caregivers, was innovative and essential to resolve patients' doubts, alleviate the fear of interaction which, according to the news published in the media, were all predictor of deaths, in this episode it was possible for the liaison team to develop their nursing actions masterfully and acquire the trust of the elderly person and their caregivers assisted by HCS.
After four weeks, it can be observed that the Rev. Latino-Am.Enfermagem 2024;32:e4320.
Safety recommendations for elderly people went far beyond those already carried out daily by caregivers.
It was necessary to intensify care and attention to preventive actions directly linked to behavior and hygiene, as the time was full of loneliness and doubts regarding the COVID-19 disease (19,22,(30)(31) .
Other results are similar to national and international studies, with regard to elderly people and their caregivers remaining in the HCS, being discharged, being hospitalized or dying after the calls or ending the calls.There was a highlight of 83.3% for the intervention group, as at the height of COVID-19, hospitalizations were intended for more serious cases such as Acute Respiratory Failure Syndrome, which culminated in an increase in the discharge of patients from the entire Hospital Network.Health Care and also in those adhered to by HCS (26)(27) .It is important to In terms of information, safeguarding the information and records obtained during telenursing is the responsibility of the professional who performed it and/or the linked health institution.The practice of telenursing requires adjustments from the parties involved -nurse and patient -that go beyond infrastructure and connectivity (21) .In this sense, the nurse forwards information to the HCS team to certify the death.
"Doing health" is carried out by the nursing team or multidisciplinary team in the most diverse contexts, so that each professional category has its own framework of knowledge and practices that aim to diagnose, prevent and recover from diseases and injuries that affect the individual., the family and the community.It is important to know that telenursing must be developed by a nursing professional with technical competence and autonomy and who knows how to distinguish an advanced nursing practice from a generalist one (32) .
The support of transitions theory was essential In view of this, it is essential that new research be developed into the effectiveness of telenursing as support for the continuity of integral health care for the elderly and their caregivers.The HCS, as it is a multidisciplinary assistance equipment, for the entire healthcare team, would enable monitoring the health of its registered participants with several possibilities for positive interventions to support the continuity of longitudinal care (33)(34) .

Conclusion
The results demonstrated the relevance of the use interventions, respectively with the NANDA-I diagnoses, were based on classifications of improved coping; caregiver support; infection control and protection against infection; assistance with self-care, essential activities of daily living, bathing/hygiene, dressing/grooming, feeding and transfer; cognitive stimulation and facilitation of self-responsibility.Thus, in the situation of the COVID-19 pandemic, with elderly people as a risk group, consequently in a vulnerable situation, with overworked caregivers, inserted in the collapsing health system, and the advancement of telenursing in the transition from in-person care to the remote, this study aimed to evaluate telenursing as a support technology in the transition of care for elderly people and their caregivers in the context of home care Rodrigues MA, Santana RF, Hercules ABS, Barros PFA, Lima CB. during the COVID-19 pandemic.The objective outcomes of the study include discharge from the Home Care Service (HCS), which means continuity of care in primary care, hospitalization or death.
interventions in the health of elderly people and their caregivers through teleconsultation, during the COVID-19 pandemic, the NANDA I and NIC domains were used.These diagnoses and interventions were chosen in view of the COVID-19 pandemic to promote and prevent the health of elderly people and their care in social isolation and aiming to control COVID-19 infection.When a situation was identified at the time of the telephone call that required urgency/emergency or inperson assistance, the HCS team was contacted by the research team and provided appropriate assistance or referral.OF THE ELDERLY PERSON -How are you?What about the elderly person?How many people are in the house?How many people on the ground?Descriptive HOUSE RESIDENTS -How many residents are there in the house?Number of residents

Figure 2 -
Figure 2 -Control and intervention group research instrument for elderly people and caregivers research was approved by the Human Research Ethics Committee of the research host institution with the Certificate of Presentation of Ethical Appreciation (CAAE) number 14354919.1.0000.5243and 43682821.6.0000.5243.Technical cooperation agreement signed with the municipality to which the HCS was linked.Regarding the recruitment of participants, the research team made the first telephone contact to explain the research that would be carried out, initially obtaining verbal consent to participate by reading the Free and Informed Consent Form (FICF) for both the elderly person and the caregiver.At the time, the confidentiality of the information was highlighted.Subsequently, during the in-person visit by the HCS team in partnership with the research team, the signature of the Free and Informed Consent Form was obtained from all participants.There were no direct risks to the participants since the nursing interventions, offered through telephone calls, were already part of the scope of guidelines and nursing care already offered to the HCS population.A slight discomfort was observed, which may have been caused by inconvenience related to the calls and possible emotional changes regarding the questions and interventions in the questionnaire, which were minimized by the researchers with active listening and offering psychological or medical support from the multidisciplinary team of the HCS.The researchers' telephone contact was made available in case of complications, guidance and referrals.Nursing care related to health promotion was offered through guidelines regarding hygiene, crowding, respect for social isolation and maintenance of better living conditions during the COVID-19 pandemic with improved emotional and functional capacity.
Nursing diagnoses such as: Fragile Elderly Syndrome, Risk of Caregiver Role Strain and Risk of Contamination and the NIC Taxonomy , the main interventions based on the respective diagnoses.
proposal, it was possible to unite the research team and the HCS multidisciplinary team through training, associate with the use of technology and put into practice the nursing care planning contained in the five uninterrupted stages of the Nursing Process systematized and composed in the connection instrument.Telenursing made it possible to provide innovative support and continuity assistance during the COVID-19 Pandemic, for elderly people and their caregivers who were hospitalized at home and at this time of social isolation, did not have access to specific health services.
Domain 7 Roles and Relationships, the justification was also given through better assistance coverage for elderly people and their caregivers in the COVID-19 pandemic.In this domain, it was due to the possible physical and emotional overload of the elderly person's caregiver.NIC interventions were justified with the objective of minimizing the deleterious effects of tension in the caregiver's role through the nursing guidelines provided in the connection instrument.In domain 11 Security and Protection, the Risk of Infection during the COVID-19 pandemic stood out.Interventions were also guided in a systematic way through the connection instrument.During the calls, it was identified and confirmed that the elderly people and their caregivers had chronic illnesses and were monitored by the HCS and the municipality's Health Care Network without any regularity.Studies corroborate that with the worsening of the COVID-19 pandemic, the care effort in general increased significantly and this was reflected in the physical and mental health of the population, especially women who, almost one in two, have chronic comorbidities that worsened during the pandemic.And, number of calls decreased in terms of diagnosing the Risk of Fragile Elderly Syndrome and was equivalent to other interventions for Risk of Contamination and Risk of Caregiver Role Strain, a positive result (p -value < 0.001).
highlight that the discharge of the elderly person and their caregivers assisted by HCS during the research was possible through the updated information that the research team transmitted to the HCS multidisciplinary team and this also provided continuity of care through technology until possible high.Given the significant results, the importance of health professionals in minimizing the effects caused by the public health calamity of the COVID-19 pandemic was clear, especially nursing workers, protagonists in controlling the transmission of this disease, both on the front line and in interventions to support the continuity of care for elderly people and their caregivers through telenursing.Therefore, the results showed that telenursing carried out by nurses as a support technology in the transition of care to elderly people and their caregivers during the COVID-19 pandemic obtained a confidence index of 95% and significance (p-value < 0.001) in all cases.domains and diagnoses studied (Roles and Relationships -Risk of Caregiver Role Strain; Safety and Protection -Risk of Contamination and Health Promotion -Risk of Frail Elderly Syndrome).The importance of telenursing in interventions carried out by the nursing team stands out, with positive results in preventing the health of elderly people and their caregivers.
to support therapeutic objectives by pointing out the results of indicators of the care process: feeling connected, interacting, being situated and developing trust and coping.Mastery was considered, because, according to the theory, in the occurrence of fluid integration between the team of nurses in supporting the care of the elderly person and caregivers, essential, in the face of crisis situations such as the pandemic, care for the elderly person became doubled as it is the group most susceptible to complications from COVID-19.This was confirmed by the reduction in the number of interventions after the first few weeks.Regarding the limitations of the study, it can be said that at the height of the pandemic, access to data on elderly people and their caregivers registered in the HCS were out of date, which made it impossible to randomize the study.These limitations led the research team to assist the HCS team in updating the records of elderly people and their caregivers affiliated with the HCS, concomitantly with the research.The scarcity of data regarding COVID-19 was also a limitation.Regarding the implications for the advancement of scientific knowledge in the area of health and nursing, it was observed that telenursing can be responsible for positive and negative implications when developed by lay people as a call center.Nursing care through telenursing can be carried out throughout the public and private health care network for elderly people, their caregivers and other citizens who require nursing interventions.Technology to support nurses demands technical and scientific skills necessary for assertive clinical decision-making.Linkage instruments based on scientific evidence are useful for directing care planning for elderly people and their caregivers during the COVID-19 pandemic.The connections must be clearly based on the disease and the role of the nurse in terms of longitudinal care for the elderly person and their caregivers assisted by the Home Care System or other health niches.Telenursing, despite already existing in the world, only during the COVID-19 pandemic, was Rodrigues MA, Santana RF, Hercules ABS, Barros PFA, Lima CB. regulated in Brazil by the Cofen/Corens System on an emergency basis to support nurses in making clinical decisions during the COVID-19 pandemic.
of scientificity regarding the use of the combination of transition theory with the diagnostic taxonomy and interventions for the continuity of care planning for elderly people and their caregivers assisted by HCS, through telenursing, with the chance of increase nine times higher when receiving care over the telephone.The nursing diagnoses highlighted in this article as Risk of Caregiver Role Strain; Risk of Frail Elderly Syndrome and Risk of Contamination and the interventions contained in the connection instrument were efficient and essential, as they allowed the objective of the study to be met in the development of telenursing to support the continuity of face-to-face care for the elderly person and their relatives.caregivers focused on preventing and promoting their health in the COVID-19 pandemic.Thus, this support through telenursing also allowed the HCS multidisciplinary team to carry out a precise analysis regarding the safe discharge of patients enrolled in the service, directing them to the Primary Health Care network for low complexity care.

The telephone directory provided had the name and age of the 392 people registered in the HCS in alphabetical order. These were divided in the form of a random draw into two different envelopes, named
20, approximately. * Rev. Latino-Am.Enfermagem 2024;32:e4320.Rodrigues MA, Santana RF, Hercules ABS, Barros PFA, Lima CB.Santana RF, Hercules ABS, Barros PFA, Lima CB.Rodrigues MA, Santana RF, Hercules ABS, Barros PFA, Lima CB.Rodrigues MA, Santana RF, Hercules ABS, Barros PFA, Lima CB.He no longer wanted to receive a face-to-face visit from HCS ‡ because of the pandemic nor the research calls (he signed the form and did not withdraw from the research) IGM = Immunoglobulin M; † IGG = Immunoglobulin G; ‡ HCS = Home Care Service; § FHU = Family Health Unit Does anyone in the house work?And do they leave the house to go to work?Nobody works Works in Essential Activities and leaves the house Works in Non-Essential Activities and leaves the house Works in Non-Essential Activities and works from home Brother of the elderly Caregiver's spouse QUESTION 11.2If so, what is the result?Didn't take the test Negative PositiveRev.Latino-Am.Enfermagem 2024;32:e4320.Act on behalf of the caregiver when overload becomes evident/Explain the operating system of the health care network, such as the call to the core of the multidisciplinary support team that will offer support to the caregiver and the family in social and psychological matters.INTERVENTION 9Encourage leisure activities at home (You can send material via WebWhats Comercial)Rev.Latino-Am.Enfermagem 2024;32:e4320.Work in EssentialActivities and leave the house Work in Non-Essential Activities and leave the house Works in Non-Essential Activities and works from homeRev.Latino-Am.Enfermagem 2024;32:e4320.*

Table 1 -
Assessment of the homogeneity of the sample of elderly people and caregivers.São Gonçalo, RJ, Brazil, 2020Rodrigues MA, Santana RF, Hercules ABS, Barros PFA, Lima CB. similar.It is noteworthy that the Kruskal-Wallis test is significant if the p-value is < 0.05.
age, number of elderly people's comorbidities and number of caregivers' comorbidities, through statistical summaries and application of the Kruskal-Wallis test, with the aim of evaluating whether the distribution of values between the control and intervention groups were When comparing residents' health assessments in relation to the groups analyzed, the most positive result was "no symptoms" in the intervention group (p-value < 0.001).

Table 2 -
Average number of interventions carried out in the intervention group with elderly people and caregivers.

Roles and Relationship Diagnosis -Risk of Caregiver Role Strain Domain 11 -Safety/security Diagnosis -Risk of Contamination Domain 1 -Health promotion Diagnosis -Risk of Frail Elderly Syndrome
*CI = Confidence interval; † Bottom = Statistics; ‡ Superior = Statistics; § P-value = Fisher's Exact Test, significant if p-value < 0.05

Table 3 -
Comparison between outcome of the control group and intervention for elderly people and caregivers.São Gonçalo, RJ, Brazil, 2020 P-value = Fisher's Exact Test, significant if p-value < 0.05; † HCS = Home Care Service *